STEMI System Barriers & Solutions

Updated:Aug 12,2010

While regions with established STEMI systems of care are a step ahead of the norm in the United States, there is room for improvement.
Not only does the American Heart Association seek to foster the development of more STEMI systems, but it also wants to lead the way in helping established systems effectively deliver the optimum level of care. The chart below examines barriers to the ideal system as well as potential solutions.

BARRIERSSOLUTIONS
Multiple interests regarding STEMI plan:
  • Competing hospitals
  • Competing cardiology groups
  • Multiple EMS providers
  • Critical care transport/helicopter access and control
Leadership of the American Heart Association through Mission: Lifeline to build consensus around what is best for patients according to:
  • Data
  • Guidelines
  • Resources
  • Local leadership
EMS challenges
  • Medical leadership
  • Destination plans
  • Limited resources
  • Multiple/private EMS providers
  • Rural areas
  • EMT STEMI standards
  • Data collection
  • Hospital follow-up
  • Training officer needs
  • False activation

Leadership of the American Heart Association through Mission: Lifeline

Leadership and cooperation with state and national offices of EMS

Creating a pathway for Integrating EMS data with hospital data for a STEMI system quality improvement monitoring

Establishing definitions for "false activation" and acceptable parameters
 

Emergency medicine challenges
  • Waiting room delays
  • Lack of ECG space
  • Cardiology consult
  • Multiple STEMI plans
  • Discrepancy over who "owns" the patient
  • Registration
  • EMTALA
  • Shock patients
  • Transfer

Leadership of the American Heart Association through Mission: Lifeline

Leadership and cooperation of  emergency physician organizations- local, state, and national

Engagement of policy makers for regulatory challenges
 

Cardiology challenges
  • 30-minute activation
  • Simultaneous STEMIs
  • False activation
  • Freestanding PCI
  • Diagnostic catheterization
  • STEMI data
  • Data feedback
  • Parking
  • Call rooms
  • Experience

Leadership of the American Heart Association through Mission: Lifeline

Leadership and cooperation of local, state, and national cardiology organizations

Payers/government challenges
  • Financial incentives/disincentives
  • National standards for STEMI
  • Quality measures
  • EMS needs
  • Competition
  • Medical dispatch
  • Certificate of need
  • Trauma system for STEMI or other cardiovascular "scenes"
Leadership of the American Heart Association through Mission: Lifeline